New 'plug' in leaky heart valve avoids need for more invasive procedure

By Kyrie O'Connor |
July 23, 2014
| Updated: July 28, 2014 1:35pm

William Maxwell, left, of Livingston, TX, speaks with his team of doctors, from left to right, Dr. Miguel Valderrábano, Dr. Stephen H. Little, and Dr. Colin M. Barker, during a post-op appointment at Houston Methodist in Houston, TX on Monday June 9, 2014. Mr. Maxwell was able to avoid a second open-heart surgery by having an unusual repair to a heart valve. (Scott Dalton/Chronicle)

Photo By Scott Dalton/Freelance

Dr. Colin Barker, left, speaks with William Maxwell of Livingston during a post-op appointment at Houston Methodist.

The new mitral valve was leaking on the outside. As Barker describes it, there was a hole the size of a dime in a valve the size of a half-dollar.
Often such a repair would require a second open-heart surgery, an inherently risky procedure thatâs tough on the patient. Barker, however, decided the hole could be fixed using an unusual, newly-minted procedure that didnât involve invasive surgery.
A catheter was threaded through a vein in Maxwellâs groin, up to the heart and from the left to the right side, with a plug made of a mesh-and-polyester hybrid fixed to the end. An electrophysiologist mapped out the route in 3D. When the plug reached its target and was released, it âacted like a corkâ in the mitral valve, Barker said.
Maxwell said he felt better almost immediately, and now, at his six-month anniversary, he still does. âI havenât felt this good in 10 years,â he said.

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Using a MitraClip

The MitraClip, manufactured by Abbott, is a fairly new product that lets cardiologists perform less invasive procedures on patients with mitral valve leaks. Patients otherwise might require open-heart surgery. Dr. Colin Barker of Houston Methodist-DeBakey Cardiovascular Center said he performs this procedure once or twice a month; just 500 have been used in patients in the U.S. so far.

Process: To use the MitraClip, a catheter is run from the groin to the heart, going from the right to the left side. The clip, about a half-inch in length, is then attached to the mitral valve to reduce the leakage.

At 6-foot-9, just the other side of 50 and working every day outdoors, William Maxwell was accustomed to feeling robust. So in the fall of 2013, when, on the way to work on a job in Louisiana, he felt a terrible pain across his back, he knew something was wrong - but he didn't know how wrong. "I thought I had the flu," said Maxwell, who lives in Livingston.

When he went in for tests, it became clear quickly that there was something amiss with Maxwell's heart. He was admitted to a hospital in Lake Charles, La., where doctors determined that the mitral valve in Maxwell's heart would have to be replaced.

The mitral valve, one of the heart's four valves, openms to allow blood to flow from the left atrium into the left ventricle. It then closes as the heart contracts and sends blood into the aorta. The valve is named after its resemblance to a bishop's high, pointed hat. The two flaplike sides are referred to as leaflets.

When it's not working right - Maxwell's had a hole in it - blood flow is impeded.

Maxwell had open-heart surgery in Lake Charles and left the hospital four or five days later. "I was walking every day, and I felt good," he said.

But a while later, and home again, he felt terrible. His heart rhythm was off, and changing medicines a couple of times did no good. "I thought it never would get right," Maxwell said.

Dr. Colin Barker, an interventional cardiologist at Houston Methodist DeBakey Heart & Vascular Center, remembers the first time he saw Maxwell, in early January. "He was so sick when I met him. He was an active guy, and he had this sudden huge change in lifestyle," Barker said.

The new mitral valve was leaking on the outside. As Barker describes it, there was a hole the size of a dime in a valve the size of a half-dollar.

Often, such a repair would require a second open-heart surgery, an inherently risky procedure that's tough on the patient. Barker, however, decided the hole could be fixed using an unusual, newly minted procedure that didn't involve invasive surgery.

A catheter, with a hybrid mesh-and-polyester plug fixed to the end, was threaded through a vein in Maxwell's groin, up to the heart and from the left to the right side. An electrophysiologist mapped out the route in 3-D. When the plug reached its target and was released, it "acted like a cork" in the mitral valve, Barker said.

Maxwell said he felt better almost immediately, and now, at his six-month anniversary, he still does. "I haven't felt this good in 10 years," he said.

Barker has also had success with another minimally invasive procedure to stop or greatly reduce a leak in a mitral valve using a small "mitral clip" to repair the leak. Only about 500 MitraClips have been inserted into patients in the U.S. so far. Barker is one of only two surgeons in Houston to use this method and said he does one or two a month.

Again, a catheter is snaked from the groin to the heart, going from the right to the left side. The clip, which Barker said looks "like a staple," is attached to the mitral valve, almost immediately reducing the amount of leakage. The clip, about a half-inch in length, is made of a nickel and titanium alloy called nitinol. If needed, a second one can also be put in place.

A small number of patients with mitral valve leakage, if not checked, go on to develop mitral regurgitation, a condition in which the blood flows back into the heart and causes blood to flow inefficiently through the body. Heart failure or an enlarged heart can be the result, Barker said.

Though the clip isn't suitable for everybody, it's a good advancement. "It's very safe, and the risks are very, very low," he said. "It's almost an outpatient procedure."

Improvement is relatively swift. "I've done this on some pretty sick people, and they have all done well," Barker says. One patient who was quite ill took six to eight weeks to notice the improvement, but in another the uptick was immediate.

"This has been science fiction forever, and now we can do these things," Barker said.